皮秒激光治疗色素增加性疾病的Meta分析

Picosecond Laser for Pigmentary Disorders:A Meta-analysis

目的:系统评价相同波长皮秒与纳秒激光治疗色素增加性疾病的临床疗效和安全性。方法:计算机检索PubMed、EMbase、Web of Science、The Cochrane Library、万方、知网、维普数据库及中国生物医学文献数据库,搜集相同波长皮秒激光对比纳秒激光治疗皮肤色素增加性疾病的随机对照试验,进行Meta分析。结果:共纳入8个RCT,其中6个为自身对照研究。皮损清除有效率、优异清除率由于异质性高,采取亚组分析,分为表皮组、真皮组及文身组。Meta分析结果显示,皮损清除有效率各组均无统计学差异;优异清除率真皮组、文身组皮秒优于纳秒激光,有显著性差异,表皮组无统计学差异;患者满意率无统计学差异,患者非常满意率皮秒激光优于纳秒激光,有显著性差异。长期不良反应皮秒低于纳秒激光,有统计学差异。结论:现有证据表明,真皮色素增加性疾病,如:太田痣、颧部褐青色痣,皮秒激光治疗效果优于纳秒激光;表皮色素增加性疾病(如:雀斑、日光性黑子)两者疗效相当;文身治疗中,皮秒激光获得优异清除率较纳秒激光可能性更高,皮秒激光副作用少于纳秒激光。皮秒激光是否优于纳秒激光需要更多的高质量研究予以验证。

Objective To assess clinical efficacy and complications between picosecond laser and nanosecond laser with same wavelength on pigmentary disorders.Methods PubMed,Embase,Web of Science,The Cochrane Library,WanFang,CNKI,VIP,CBM database were searched to collect randomized controlled trials(RCTs)on picosecond laser and nanosecond laser for pigmentary disorders.Meta-analysis was performed.Results A total of 8 RCTS were included,6 of which were selfcontrolled design.According to heterogeneity,the effective rate and the excellent rate of pigment clearance was analysised in subgroup and divided into epidermis group,dermis group,tattoo group.The effective rate of pigment clearance in each group showed no significant difference.The excellent rate of pigment clearance in dermis group and tattoo group showed significant difference,picosecond laser is better than nanosecond laser,but there was no significant difference in epidermis group.Besides,there was significant difference in the rate of patient’s very satisfaction,picosecond laser is better than nanosecond laser.The rate of patient’s satisfaction showed no statistically significant difference.Picosecond laser has fewer long-term adverse reactions than nanosecond laser,with statistically significance.Conclusion Current evidence indicates that picosecond laser is better than nanosecond laser for dermal pigmentary disorders,such as nevus of Ota and nevus fuscocaeruleus zygomaticus.Picosecond laser is equivalent to nanosecond laser in epidermal pigmentary disorders(such as freckles,solar lentigines)treatment.In tattoo treatment,picosecond laser are more likely to achieve excellent clearance than nanosecond laser.The picosecond laser has fewer adverse effects than the nanosecond laser.Whether picosecond laser is better than nanosecond laser requires more high-quality studys to prove.